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Background: Smoking, alcohol use, and depression are interrelated and highly prevalent in patients with head and neck cancer, adversely affecting quality of life and survival. Smoking, alcohol, and depression share common treatments, such as cognitive behavioral therapy and antidepressants. Consequently, we developed and tested a tailored smoking, alcohol, and depression intervention for patients with head and neck cancer. Methods: Patients with head and neck cancer with at least one of these disorders were recruited from the University of Michigan and three Veterans Affairs medical centers. Subjects were randomized to usual care or nurseadministered intervention consisting of cognitive behavioral therapy and medications. Data collected included smoking, alcohol use, and depressive symptoms at baseline and at 6 months.

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Background: Patients with head and neck cancer often experience debilitating speech, eating, and respiratory problems as well as the psychological effects of loss of function and change in body image. These patients often become unemployed as a result of their disease process, which adds financial burden to their already stressful lives. Yet the specific factors associated with unemployment have not been systematically studied.Methods: This multisite study used survey and chart data to determine the predictors of work-related disability.Results: Of the 384 patients who were working prior to their diagnosis of head and neck cancer, 52% (n=201) were disabled by their cancer treatment. Multivariate analysis demonstrated significant links between disabil-ity and chemotherapy (odds ratio [OR], 3.4; PϽ.001), neck dissection status (OR, 2.3; P=.01), pain scores (OR, 1.2; P =.01), and time since diagnosis (OR, 0.9; P=.04).Conclusions: More than half of the patients in this study were disabled by their head and neck cancer or treatment. Patients with head and neck cancer who have undergone chemotherapy or neck dissection or have high pain scores are at increased risk for disability from their cancer or their treatment. Efforts to prevent (if possible), better assess, and treat pain and other adverse effects of head and neck cancer treatments may also have the potential to reduce patient disability.

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A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied). Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.

Over the years, frequent conversations with Drs. Dale Walker and Pat Silk-Walker impressed upon me the careful thought that had been invested in their longitudinal study of alcohol use and abuse among a large sample of urban Indians, with special emphasis on the mother/child dyad. As we talked, there was little doubt in my mind that the empirical findings of this work would find its way into a variety of professional and public forums. However, many of the issues that we discussed at greatest length had to do with the opportunities for and challenges of conducting longitudinal research in this special population. Those issues touched upon matters of science -e.g., sampling, recruitment, retention, analysis, participant confidentiality -as well as local benefit -e.g., community participation, feedback, and programmatic application. The lessons learned about these matters seemed much less likely to be published. Most professional journals, today, are interested only in what they consider to be the "meat" or substance of a study; the "doing" of research often is considered outside of this domain. Ironically, with respect to longitudinal work in particular, thoughtful reflection on the latter is precisely what is now needed. Thus, Walker et al.'s offer to author a manuscript along these lines, employing their current experience as the central speaking point, was fortuitous: an offer I quickly accepted.In the pages that follow, then, the reader is treated to a sophisticated presentation of research methods employed in a longitudinal fashion and comments by other investigators who have shared similar struggles. The result is a wonderful discussion of ideas, approaches, and priorities that is sure to instruct all of us. This exchange adds in important ways to the dialogue surrounding the potential and the pitfalls of studying the human condition over time.